Systems and methods for workflow modification through metric analysis

ABSTRACT

An example system to manage a radiologist workflow includes a first interface to monitor a distribution status of at least one medical exam. The medical exam is to be at least one of automatically allocated or assigned to an examiner work queue based on one or more rules. The example system includes a second interface to view at least one metric associated with distribution of the at least one medical exam and an assignment tool to be displayed via the first interface. The assignment tool is to facilitate assignment of the medical exam to an examiner work queue. The example system includes a rules viewer to be displayed via a third interface. The rules viewer is to facilitate configuration of the one or more rules based on the distribution status, the at least one metric, or the assignment. The rules viewer is to automatically update the one or more rules.

RELATED APPLICATIONS

This patent arises as a continuation of U.S. patent application Ser. No.14/091,812, entitled “Systems and Methods for Workflow ModificationThrough Metric Analysis,” filed Nov. 27, 2013. U.S. patent applicationSer. No. 14/091,812 is hereby incorporated by reference in its entirety.

FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

[Not Applicable]

MICROFICHE/COPYRIGHT REFERENCE

[Not Applicable]

BACKGROUND

Healthcare environments, such as hospitals or clinics, includeinformation systems, such as hospital information systems (HIS),radiology information systems (RIS), clinical information systems (CIS),and cardiovascular information systems (CVIS), and storage systems, suchas picture archiving and communication systems (PACS), libraryinformation systems (LIS), and electronic medical records (EMR).Information stored can include patient medication orders, medicalhistories, imaging data, test results, diagnosis information, managementinformation, and/or scheduling information, for example.

Medical exam results stored in, for example, the radiology informationsystem, require review by an examining radiologist. Distribution of theexams for review by the radiologist involves consideration of variousfactors, including, for example, radiologist workloads, examcharacteristics, available resources, and/or hospital efficiency goals.Such considerations are often present across a network of radiologists,hospitals, and/or institutions. Efforts to manage exam distribution inview of institutional work flow goals can be time-consuming,inefficient, and result in inequities with respect to the distributionof the medical exams for review. Further, hospital administrators lackefficient tools for managing radiologist workflows, analyzing metricsassociated with the distribution of exams, and dynamically implementingworkflow modifications based on the metric analysis.

BRIEF SUMMARY

Certain examples provide methods, systems, and machine readable storagedevices or storage discs for managing radiologist workflows. Certainexamples provide a system to manage radiologist workflow. The examplesystem includes a first interface to monitor a distribution status of atleast one medical exam. The medical exam is to be at least one ofautomatically allocated or assigned to an examiner work queue based onone or more rules. The example system includes a second interface toview at least one metric associated with distribution of the at leastone medical exam. The example system includes an assignment tool to bedisplayed via the first interface. The assignment tool is to facilitateassignment of the medical exam to an examiner work queue. The examplesystem includes a rules viewer to be displayed via a third interface.The rules viewer is to facilitate configuration of the one or more rulesbased on the distribution status, the at least one metric, or theassignment. In the example system, the rules viewer to automaticallyupdate the one or more rules.

Certain examples provide a method for monitoring radiologist workflow.The example method includes monitoring a distribution status of at leastone medical exam via a first interface. In the example method, themedical exam is to be at least one of automatically allocated orassigned to an examiner work queue based on one or more rules. Theexample method includes displaying at least one metric associated withthe distribution of the at least one medical exam via a secondinterface. The example method includes facilitating an assignment of themedical exam to an examiner work queue via the first interface. Theexample method also includes facilitating a configuration of the one ormore rules based on the distribution status, the at least one metric, orthe assignment via the first interface. The example method includesautomatically updating the one or more rules.

Certain examples provide a machine readable storage device or storagedisc storing instruction thereon, which, when read, cause a machine toat least monitor a distribution status of at least one medical exam viaa first interface. The medical exam is to be at least one ofautomatically allocated or assigned to an examiner work queue based onone or more rules. The example instructions cause the machine to displayat least one metric associated with the distribution of the at least onemedical exam via a second interface. The example instructions also causethe machine to facilitate an assignment of the medical exam to anexaminer work queue via the first interface. The example instructionscause the machine to facilitate a configuration of the one or more rulesbased on the distribution status, the at least one metric, or theassignment via the first interface. The example instructions also causethe machine to automatically update the one or more rules.

BRIEF DESCRIPTION OF SEVERAL VIEWS OF THE DRAWINGS

FIG. 1 is a block diagram of an example medical exam distributor in anexample healthcare system.

FIG. 2 is a block diagram of the example medical exam distributor ofFIG. 1.

FIG. 3 illustrates an example first screen of an example graphical userinterface associated with the example medical exam distributor of FIG.1.

FIG. 3b illustrates a second view of the example first screen of FIG. 3.

FIG. 4 illustrates an example second screen of an example graphical userinterface associated with the example medical exam distributor of FIG.1.

FIG. 5 illustrates an example third screen of the example graphical userinterface associated with the example medical exam distributor of FIG.1.

FIG. 6 illustrates an example fourth screen of the example graphicaluser interface associated with the example medical exam distributor ofFIG. 1.

FIG. 7 illustrates an example fifth screen of the example graphical userinterface associated with the example medical exam distributor of FIG.1.

FIG. 8 illustrates an example sixth screen of the example graphical userinterface associated with the example medical exam distributor of FIG.1.

FIG. 9 depicts an interactive relationship between the example medicaldistributor of FIG. 1 and the example screens of FIGS. 3-8.

FIG. 10 is a flow diagram illustrating an example method for managingexam distribution via an example graphical user interface associatedwith the example medical exam distributor of FIG. 1.

FIG. 11 is a flow diagram illustrating an example method for optimizingexam distribution by the example medical exam distributor of FIG. 1.

FIG. 12 shows a block diagram of an example processor system that can beused to implement systems and methods described herein.

The foregoing summary, as well as the following detailed description ofcertain examples of the present disclosure, will be better understoodwhen read in conjunction with the appended drawings. For the purpose ofillustrating the disclosure, certain examples are shown in the drawings.Wherever possible, the same reference numbers will be used throughoutthe drawing(s) and accompanying written description to refer to the sameor like parts. It should be understood, however, that the presentdisclosure is not limited to the arrangements and instrumentality shownin the attached drawings.

DETAILED DESCRIPTION OF CERTAIN EXAMPLES

Although the following discloses example methods, systems, and machinereadable storage devices and storage discs including, among othercomponents, software executed on hardware, it should be noted that suchmethods and apparatus are merely illustrative and should not beconsidered as limiting. For example, it is contemplated that any or allof these hardware and software components could be embodied exclusivelyin hardware, exclusively in software, exclusively in firmware, or in anycombination of hardware, software, and/or firmware. Accordingly, whilethe following describes example methods, systems, and machine readablestorage devices and storage discs, the examples provided are not theonly way to implement such methods, systems, and machine readablestorage devices and storage discs.

Also, although the methods, systems and machine readable storage mediumsdisclosed here are described in regards to healthcare applications,including, but not limited to, radiology information systems, it is tobe understood that the present methods, systems and machine readablestorage mediums can also be used to distribute information in any otherindustry/application.

A medical exam conducted on a patient can involve review by a healthcarepractitioner to obtain, for example, diagnostic information from theexam. In a hospital setting, medical exams can be ordered for aplurality of patients, all of which require review by an examiningpractitioner. Each exam has associated attributes, such as a modality, apart of the human body under exam, and/or an exam priority level relatedto a patient criticality level. Hospital administrators, in managingdistribution of exams for review by practitioners, can consider the examattributes as well as staff availability, staff credentials, and/orinstitutional factors such as service level agreements and/or overheadcosts. Balancing practitioner workloads in view of the exams requiringreview can involve time-consuming efforts that result in inefficienciesand/or inequities in exam distribution across a network ofpractitioners. Further, some practitioners habitually decline to reviewand/or select to review exams having certain attributes. Load-balancingrules that automatically allocate exams to practitioners while allowingfor a user, such as an administrator and/or a practitioner, to reviewthe allocation and control assignment of the exams provide for efficientmanagement of practitioner workloads in view of hospital workflow goalsand clinical targets.

Additionally, an administrator may wish to view metrics or statisticsassociated with the distribution and review status of exams across thenetwork, hospital, and/or institution. Such metrics can relate to, forexample, radiologist performance, exam review efficiency, revenues,and/or whether certain contractual targets with respect to exam reviewhave been met. In some examples, the administrator seeks to implementchanges to the workflow allocation based on a review of the metrics. Asystem that generates current and historical operational statisticsassociated with exam distribution and allows for the administrator todynamically influence workload allocation outcomes provides for adata-driven approach to workflow efficiency. Further, a system thatautomatically optimizes workflow allocation based on the current andhistorical data as well as inherent characteristics of the healthcareenvironment provides for a responsive approach to exam distribution andshared workload management in view of institutional goals.

Disclosed herein are example systems, methods, and machine readablestorage devices and storage discs that provide for management of thedistribution of medical exams to examining practitioners. The disclosedexample systems, methods, and machine readable storage devices andstorage discs can be used as part of a radiology information system tooversee the distribution of radiology medical exams to radiologists forreview. The examples disclosed herein include graphical user interfacesaccessible by one or more administrators of a radiology network,institution (e.g., a hospital), and/or group of institutions to review,influence, and/or improve workflow allocation. The examples disclosedherein also include an optimizer to automatically monitor the workflowallocation, evaluate user feedback via the graphical user interfaces,and implement process improvements directed toward increases workflowefficiency.

The disclosed example graphical user interfaces facilitate management ofworkload allocation across a network by providing for an administratorto view real-time information about the distribution statuses of examsrequiring review by a radiologist. For example, the administrator canmonitor the allocation and/or assignment status of exams to radiologistwork queues. The administrator can also view one or more examcharacteristics via the graphical user interfaces, including, forexample, an amount of time allocated for reviewing the exam based oncontractual agreements with healthcare insurance providers.Additionally, the example graphical user interfaces facilitateadministrative review of network- and/or institutional-level operationalstatistics. In generating both real-time and historical operationalstatistics, the example graphical user interfaces enable theadministrator to analyze exam distribution outcomes in view of workflowtargets. In further examples, the example graphical user interfacesprovide for the administrator to adjust the workflow allocation byrevising one or more parameters defining the load-balancing rules. Insome examples, the administrator can enact the parameter updates at aradiologist-level and/or across the radiologist network. Changesimplemented by the administrator to, for example, radiologist workflowsvia the example user interfaces described herein are dynamicallyreflected across graphical user interfaces viewable by the radiologistsin the network.

Examples disclosed herein also facilitate automated improvements oroptimizations to the load-balancing rules based on current andhistorical data collected from ongoing monitoring of exam distributionand user feedback. Examples disclosed herein provide for analysis of theexam distribution data with a view toward improving the allocationprocess and increasing efficiency in workflow management. In dynamicallygenerating and implementing improvements during the exam distributionprocess, examples disclosed herein provide for a responsive, analyticalapproach to workflow allocation.

Turning now to the figures, FIG. 1 shows a block diagram of an examplehealthcare system 100 capable of implementing an example medical examdistributor 102. The example healthcare system 100 includes the examplemedical exam distributor 102, a hospital information system (HIS) 104, aradiology information system (RIS) 106, a picture archiving andcommunication system (PACS) 108, an interface unit 110, a data center112, and a workstation 114. In the illustrated example, the HIS 104, theRIS 106, and the PACS 108 are housed in a healthcare facility andlocally archived. However, in other implementations, the HIS 104, theRIS 106, and/or the PACS 108 can be housed one or more other suitablelocations. In certain implementations, one or more of the PACS 108, RIS106, HIS 104, etc., can be implemented remotely via a thin client and/ordownloadable software solution. Furthermore, one or more components ofthe healthcare system 100 can be combined and/or implemented together.For example, the RIS 106 and/or the PACS 108 can be integrated with theHIS 104; the PACS 108 can be integrated with the RIS 106; and/or thethree example information systems 104, 106, and/or 108 can be integratedtogether. In other example implementations, the healthcare system 100includes a subset of the illustrated information systems 104, 106,and/or 108. For example, the healthcare system 100 can include only oneor two of the HIS 104, the RIS 106, and/or the PACS 108. Information(e.g., scheduling, test results, exam image data, observations,diagnosis, etc.) can be entered into the HIS 104, the RIS 106, and/orthe PACS 108 by healthcare practitioners (e.g., radiologists,physicians, and/or technicians) and/or administrators before and/orafter patient examination.

The HIS 104 stores medical information such as clinical reports, patientinformation, and/or administrative information received from, forexample, personnel at a hospital, clinic, and/or a physician's office.The RIS 106 stores information such as, for example, radiology reports,radiology exam image data, messages, warnings, alerts, patientscheduling information, patient demographic data, patient trackinginformation, and/or physician and patient status monitors. Additionally,the RIS 106 enables exam order entry (e.g., ordering an x-ray of apatient) and image and film tracking (e.g., tracking identities of oneor more people that have checked out a film). In some examples,information in the RIS 106 is formatted according to the HL-7 (HealthLevel Seven) clinical communication protocol. In certain examples, themedical exam distributor 102 is located in the RIS 106 to facilitatedistribution of radiology exams to a radiologist workload for review andmanagement of the exam distribution by, for example, an administrator.In an alternative example, the exam distributor 102 can be locatedseparately or can be included in any other suitable device of thehealthcare system 100.

The PACS 108 stores medical images (e.g., x-rays, scans,three-dimensional renderings, etc.) as, for example, digital images in adatabase or registry. In some examples, the medical images are stored inthe PACS 108 using the Digital Imaging and Communications in Medicine(“DICOM”) format. Images are stored in the PACS 108 by healthcarepractitioners (e.g., imaging technicians, physicians, radiologists)after a medical imaging of a patient and/or are automaticallytransmitted from medical imaging devices to the PACS 108 for storage. Insome examples, the PACS 108 can also include a display device and/orviewing workstation to enable a healthcare practitioner or provider tocommunicate with the PACS 108.

The interface unit 110 includes a hospital information system interfaceconnection 116, a radiology information system interface connection 118,a PACS interface connection 120, and a data center interface connection122. The interface unit 110 facilities communication among the HIS 104,the RIS 106, the PACS 108, and/or the data center 112. The interfaceconnections 116, 118, 120, and 122 can be implemented by, for example, aWide Area Network (“WAN”) such as a private network or the Internet.Accordingly, the interface unit 110 includes one or more communicationcomponents such as, for example, an Ethernet device, an asynchronoustransfer mode (“ATM”) device, an 802.11 device, a DSL modem, a cablemodem, a cellular modem, etc. In turn, the data center 112 communicateswith the workstation 114, via a network 124, implemented at a pluralityof locations (e.g., a hospital, clinic, doctor's office, other medicaloffice, or terminal, etc.). The network 124 is implemented by, forexample, the Internet, an intranet, a private network, a wired orwireless Local Area Network, and/or a wired or wireless Wide AreaNetwork. In some examples, the interface unit 110 also includes a broker(e.g., a Mitra Imaging's PACS Broker) to allow medical information andmedical images to be transmitted together and stored together.

The interface unit 110 receives images, medical reports, administrativeinformation, exam workload distribution information, and/or otherclinical information from the information systems 104, 106, 108 via theinterface connections 116, 118, 120. If necessary (e.g., when differentformats of the received information are incompatible), the interfaceunit 110 translates or reformats (e.g., into Structured Query Language(“SQL”) or standard text) the medical information, such as medicalreports, to be properly stored at the data center 112. The reformattedmedical information can be transmitted using a transmission protocol toenable different medical information to share common identificationelements, such as a patient name or social security number. Next, theinterface unit 110 transmits the medical information to the data center112 via the data center interface connection 122. Finally, medicalinformation is stored in the data center 112 in, for example, the DICOMformat, which enables medical images and corresponding medicalinformation to be transmitted and stored together.

The medical information is later viewable and easily retrievable at theworkstation 114 (e.g., by their common identification element, such as apatient name or record number). The workstation 114 can be any equipment(e.g., a personal computer) capable of executing software that permitselectronic data (e.g., medical reports) and/or electronic medical images(e.g., x-rays, ultrasounds, MRI scans, etc.) to be acquired, stored, ortransmitted for viewing and operation. The workstation 114 receivescommands and/or other input from a user via, for example, a keyboard,mouse, track ball, microphone, etc. The workstation 114 is capable ofimplementing a user interface 126 to enable a healthcare practitionerand/or administrator to interact with the healthcare system 100. Forexample, in response to a request from a physician, the user interface126 presents a patient medical history. In other examples, a radiologistis able to retrieve and manage a workload of exams distributed forreview to the radiologist by the medical exam distributor 102 via theuser interface 126. In further examples, an administrator reviewsradiologist workloads, exam allocation, and/or operational statisticsassociated with the distribution of exams by the medical examdistributor 102 via the user interface 126. In some examples, theadministrator adjusts one or more settings or outcomes of the medicalexam distributor 102 via the user interface 126.

The example data center 112 of FIG. 1 is an archive to store informationsuch as, for example, images, data, medical reports, and/or, moregenerally, patient medical records. In addition, the data center 112 canalso serve as a central conduit to information located at other sourcessuch as, for example, local archives, hospital informationsystems/radiology information systems (e.g., the HIS 104 and/or the RIS106), or medical imaging/storage systems (e.g., the PACS 108 and/orconnected imaging modalities). That is, the data center 112 can storelinks or indicators (e.g., identification numbers, patient names, orrecord numbers) to information. In the illustrated example, the datacenter 112 is managed by an application server provider (“ASP”) and islocated in a centralized location that can be accessed by a plurality ofsystems and facilities (e.g., hospitals, clinics, doctor's offices,other medical offices, and/or terminals). In some examples, the datacenter 112 can be spatially distant from the HIS 104, the RIS 106,and/or the PACS 108 (e.g., at General Electric® headquarters).

The example data center 112 of FIG. 1 includes a server 128, a database130, and a record organizer 132. The server 128 receives, processes, andconveys information to and from the components of the healthcare system100. The database 130 stores the medical information described hereinand provides access thereto. The example record organizer 132 of FIG. 1manages patient medical histories, for example. The record organizer 132can also assist in procedure scheduling, for example.

The example medical exam distributor 102 identifies a medical examneeding review and facilitates distribution of the exam to an examiner,such as a radiologist. The medical exam can be stored in the data center112 or located in any other component of the healthcare system 100. Insome examples, the exam distributor 102 can distribute one or more examsto a radiologist using pre-defined load-balancing rules based on one ormore characteristics associated with an exam, an examiner, a network ofexaminers, and/or a healthcare environment.

In some examples, the administrator reviews one or more operationalstatistics associated with the distribution of the exams by the medicalexam distributor 102 across the RIS 106. The administrator can implementone or more adjustments directed to the distribution of the exams by themedical exam distributor 102, based on, for example, the operationalstatistics. The medical exam distributor 102 dynamically responds touser inputs related to, for example, allocation of exams,acceptance/rejection of exams, assignment of exams, radiologistavailability, resource availability, exam characteristics, and/or otheruser interaction via the user interface 126 to efficiently distributeexams to a reviewing radiologist's workflow in view of administrativereview goals. The medical exam distributor 102 further automaticallyoptimizes exam allocation based on the user inputs as well as patternsand trends detected from monitoring of exam distribution and review. Infacilitating sharing of exam distribution statuses and/or radiologistcharacteristics between practitioners and administrators associated withthe RIS 106, the medical exam distributor 102 provides for a dynamicworkflow management system.

FIG. 2 shows a block diagram of the exam distributor 102 of FIG. 1. Forexample, the exam distributor 102 can be associated with the radiologyinformation system of FIG. 1. The exam distributor 102 includes adisplay module 200, which interacts, for example, with the userinterface 126 of the system 100 of FIG. 1. As will be described below(FIGS. 3-8), in some examples, the user interface 126 is anadministrator user interface 202 accessible by, for example, a hospitalor radiology department administrator. In further examples, the userinterface 126 is an examiner user interface 204 a-n accessible by one ormore radiologists. The display module 200 can connect to any computerscreen, image viewer and/or other display device known to those skilledin the art. The example exam distributor 102 also includes a user inputmodule 206 for receiving, for example, a user input from one or more ofthe administrator user interface 202 and/or the examiner user interfaces204 a-n.

The example exam distributor 102 also includes a profile creator 208.The profile creator 208 provides for the creation and/or modification ofone or more radiologist profiles by a radiologist via the user inputmodule 206. Profiles created via the profile creator 208 can define, forexample, a radiologist's specialty, availability, preferred examattributes, workload capacity, and/or other characteristics associatedwith the radiologist at select times or on certain days of the week. Aradiologist can select a profile via, for example, the examiner userinterface 204 a, which defines the radiologist's capacity to receiveexams for review. In distributing exams for review, the exam distributor102 at least partially considers the availability and/or workload of aradiologist based on one or more profiles when allocating and/orassigning an exam to the radiologist.

The example exam distributor 102 includes a rules creator 210. The rulescreator 210 defines one or more rules used in automatically allocatingan exam to a radiologist. In some examples, an administrator can define,for example, one or more departmental and/or institutional rules via theadministrator user interface 202 and the user input module 206. Also, insome examples, the rules creator 210 creates rules based on radiologistprofiles created by the profile creator 208. In other examples, therules creator 210 defines one or more load-balancing rules based on, forexample, radiologist workload thresholds, radiologist specialties,preferred radiologists, exam priority levels, and/or exam difficultylevels. In implementing the rules creator 210, the example examdistributor 102 optimizes distribution of an exam to a radiologist baseda combination of rules associated with a radiologist profile, one ormore exam attributes, and/or healthcare administration to match an examwith a reviewing radiologist. Also, in some examples where the examdistributor 102 is implemented across two or more institutions, therules creator 102 performs a mapping of identifiers associated with theexams and/or the healthcare institutions to standardize examdistribution between institutions. For example, factors such as exammodality, body part, radiologist specialty, and/or institution locationare considered by the rules creator as part of defining load-balancingrules. Such mapping across affiliated institutions provides forconsistency in applying the load-balancing rules and benchmarks forcomparing workload information between radiologists at differentinstitutions.

As shown, the example exam distributor also includes an allocationmanager 212. The allocation manager 212 automatically allocates an examto a radiologist for review. For example, the allocation manager 212automatically allocates the exam to the radiologist based on one or morerules defined by the rules creator 210. In some examples, the allocationmanager 212 automatically allocates an exam to a preferred radiologistbased on the radiologist's current workload or workload threshold,specialty, and/or availability. In other examples, the allocationmanager 212 automatically allocates the exam to a radiologist based onexam attributes, such as an exam priority level or a service levelagreement requiring the exam to be reviewed within a certain amount oftime. In further examples, the allocation manager 212 allocates the examto a radiologist based on one or more combinations of the aforementionedexam and/or radiologist properties.

The example exam distributor 102 also includes an assignment manager214. The assignment manager 214 assigns an exam to a radiologist. Asdescribed above, the allocation manager 212 automatically allocate theexam to the radiologist. However, prior to the allocated exam beingreviewed by the radiologist, the radiologist and/or an administrator canreview the allocation of the exam to the radiologist via the display 200(e.g., by interacting with the examiner user interface 204 a-n or theadministrator user interface 202). Based on, for example, theradiologist's workload, availability, or an exam attribute, theradiologist and/or the administrator can selectively confirm and/orreject the allocation of the exam to the radiologist or decide toredirect the exam to another radiologist for review. The assignmentmanager 214 facilitates the radiologist's and/or the administrator'sdecision by confirming assignment and/or acceptance of the exam to theradiologist's workflow.

In other examples, the assignment manager 214 assigns the exam to theradiologist without the allocation manager 212 first allocating the examto the radiologist. For example, a radiologist, via the user interface204 a-n can direct the assignment manager 214 to assign an unallocatedexam to the radiologist's work queue. In other examples, one or morerules defined by the rules creator 210 can bypass the allocation of theexam to the radiologist and cause the assignment manager 214 toautomatically assign the exam to the radiologist's workflow withoutrequiring further confirmation.

In other examples, the assignment manager 214 automatically assigns theexam to the radiologist based on radiologist schedules or rules definingpreferences for assignment based on exam and/or radiologist attributes.In further examples, the assignment manager 214 automatically deliversexams to the radiologist based on a selection by the radiologist toreceive exams for substantially immediate review via the examinerinterface 204 a-n, rather than delivering exams to the radiologist'swork queue for review at a later time. In such examples, the assignmentmanager 214 can be considered to operate in auto-serve mode such thatexams are successively assigned to the radiologist for real-time review.

The example exam distributor 102 also includes a database 216. Thedatabase 216 stores information concerning distribution rules, examallocation information, and/or allocation information. The database 216also stores information related to one or more radiologists, such asavailability and/or profiles. The database 216 also stores informationprovided to the exam distributor 102 via the user input module 206.Further, the database 216 stores real-time or historical data associatedwith the distribution and review of exams during operation of the examdistributor 102. For example, during operation of the exam distributor102, data is generated associated with the exam distribution status,acceptance of exams by radiologists, exam review time, radiologistavailability, revenue, etc. Such data can be collected and stored by thedatabase 216. In some examples, the database 216 stores informationassociated with one or more affiliated institutions in view of examsperformed at the individual institutions.

The example exam distributor 102 includes a calculator 218. Thecalculator 218 generates one or more metrics or statistics based on thedata stored in the database 216. Using, for example, data miningtechniques, statistical analysis, etc., the calculator 216 generatesmetrics that provide for real-time and/or historical review of theoperation of the exam distributor 102. In some examples, the calculator216 dynamically updates the metric calculations in response to, forexample, user inputs provided via the user input module 205 oradjustments to the allocation manager 212 or the assignment manager 214.In some examples, statistics such as review efficiency and workload areadjusted to account for exams reviewed in auto-serve mode.

The example exam distributor includes an optimizer 220. The optimizer220 monitors the status of the exam allocation and assignment by theallocation and assignment managers 212, 214 and the metrics calculatedby the calculator 218. The optimizer also evaluates user inputs receivedvia the user input module 206 and considers external influences andconstraints, such as hospital legal obligations and building resources.As a result of the monitoring, the optimizer 220 detects and analyzespatterns and trends related to the exam distribution. For example, theoptimizer 220 detects areas of the workflow allocation process thatresult in inefficiencies. Further, the optimizer generates improvementsto the exam distribution process, including adjustments to one or morerules defined by the rules creator 210. In operation, the optimizer 220can employ data mining techniques as well as process improvementstrategies and tools, including but not limited to, Six Sigma, leanoptimization, multivariable testing, capability maturity modelintegrator (CMMI), behavioral approaches, and/or combinations of globaloptimization models to drive increase workflow efficiency.

In the example shown, the components of the exam distributor 102,including the display module 200, the user input module 206, the profilecreator 208, the rules creator 210, the allocation manager 212, theassignment manager 214, the database 216, the calculator 218, and/or theoptimizer 220 are in communication with each other via a communicationslink 222. The communications link 222 can be any type of wiredconnection (e.g., a databus, a USB connection, etc.) and/or any type ofwireless communication (e.g., radio frequency, infrared, etc.) using anypast, present, or future communication protocol (e.g., Bluetooth, USB2.0, USB 3.0, etc.). Also, the components of the example examdistributor 102 can be integrated in one device or distributed over twoor more devices.

While an example manner of implementing the exam distributor 102 of FIG.1 is illustrated in FIG. 2, one or more of the elements, processesand/or devices illustrated in FIG. 2 can be combined, divided,re-arranged, omitted, eliminated and/or implemented in any other way.Further, the display module 200, the user input module 206, the profilecreator 208, the rules creator 210, the allocation manager 212, theassignment manager 214, the database 216, the calculator 218, theoptimizer 220 and/or, more generally, the example exam distributor 102of FIG. 2 can be implemented by hardware, software, firmware and/or anycombination of hardware, software and/or firmware. Thus, for example,any of the example display module 200, the user input module 206, theprofile creator 208, the rules creator 210, the allocation manager 212,the assignment manager 214, the database 216, the calculator 218, theoptimizer 220, and/or, more generally, the example exam distributor 102could be implemented by one or more analog or digital circuit(s), logiccircuits, programmable processor(s), application specific integratedcircuit(s) (ASIC(s)), programmable logic device(s) (PLD(s)) and/or fieldprogrammable logic device(s) (FPLD(s)). When reading any of theapparatus or system claims of this patent to cover a purely softwareand/or firmware implementation, at least one of the example displaymodule 200, the user input module 206, the profile creator 208, therules creator 210, the allocation manager 212, the assignment manager214, the database 216, the calculator 218, the optimizer 220 and/or theexam distributor 102 is/are hereby expressly defined to include atangible computer readable storage device or storage disk such as amemory, a digital versatile disk (DVD), a compact disk (CD), a Blu-raydisk, etc. storing the software and/or firmware. Further still, theexample exam distributor 102 of FIG. 1 can include one or more elements,processes and/or devices in addition to, or instead of, thoseillustrated in FIG. 2, and/or can include more than one of any or all ofthe illustrated elements, processes and devices.

FIG. 3 shows the example user interface 126 for interacting with theexample exam distributor 102 of FIG. 2. The example user interface 126can include one or more screens for interacting with the example examdistributor 102, as will be discussed herein in connection with FIG. 3and FIGS. 4-8 (below).

In particular, FIG. 3 depicts an example first screen 300 of the userinterface 126 viewable by an administrator (e.g., the administrator userinterface 202 of FIG. 2). The example first screen 300 displaysinformation associated with the distribution of exams by the examdistributor 102. In some examples, the first screen 300 is a dashboardproviding an exam status summary of one or more exams requiring reviewacross a radiology department, a hospital, and/or a network ofdepartments or healthcare institutions.

The first screen 300 includes an exam identifier 302. In some examples,the exam identifier 302 is a visual representation of one or more examsrequiring review by a radiologist. The exam identifier 302 includes, forexample, a name of a patient on which the exam was conducted, an imageof the patient, a procedural code, a body part on which the exam wasconducted, an exam modality, and/or a time at which the exam wasconducted. The exam identifier 302 can also include other, customizableinformation regarding the exam.

The example first screen 300 also displays one or more exam attributeidentifiers 304 that are representative of one or more exam attributes.For example, if a patient is in critical condition and the exam requiresurgent review by a practitioner, the exam attribute identifier 304 ishighlighted to indicate a priority level associated with the exam. Otherexam attribute identifiers 306, 308 can indicate the body part thatforms the subject of the exam, whether an exam has been dictated by apractitioner, a name of a prescribing radiologist, a name of radiologistto which the patient has been referred, and/or a relative value unitrepresentative of a difficulty level of the exam. Other exam attributescan be selectively displayed, hidden, and/or removed from the examplefirst screen 300.

The example first screen 300 of the user interface 126 displays one ormore exam status identifiers 306, 308, 310. The exam status identifiers306, 308, 310 are visual indications of the status of the distributionof an exam to a radiologist based on implementation of the examdistributor 102 (including, for example, implementation of the rulesdefined by the rules creator 210 of FIG. 2). Further, the exam statusidentifiers 306, 308, 310 dynamically update in response tocommunicative interactions with the exam distributor 102 via, forexample, the user interface 126 (e.g., the administrator user interface202 and/or the examiner user interface 204 a-n). The example firstscreen 300 also displays an examiner identifier 314 representative ofthe name of the radiologist to whom the exam has been allocated,assigned, and/or queued.

For example, a first exam status identifier 306 indicates whether anexam has been assigned, via, for example, the assignment manager 214, toa radiologist. A second exam status identifier 308 indicates whether theexam has been allocated to a radiologist, via, for example, theallocation manager 212. A third exam status identifier 310 representswhether, for example, an exam assigned to a radiologist has beenaccepted for review by the radiologist and moved to the radiologist'swork queue (FIG. 4).

The example first screen 300 also displays an alert 316 displayed on theexample first screen 300 to indicate whether an exam is reaching a timelimit for review. In some examples, an exam is associated with a servicelevel agreement between, for example, a hospital and a health insuranceprovider, that specifies a time period for review of the exam in orderto receive payment. The alert 316 is a visual representative of theexpiration of the allocated time for review and whether or not the examis nearing the expiration time. In some examples, the alert 316indicates, for example, using via color coding, whether the timeallocated for review is past the expiration time, within a threshold ofthe expiration time, or not yet near the threshold. For example, anunallocated exam associated with the alert 316 representing that theexam is nearing the expiration time can drive an administrator'sdecision to manually assign the exam to a radiologist so that the examdoes not past the expiration time. Also, in some examples, the alert 316is shared across the administrator and examiner user interfaces 202, 204a-n to provide for monitoring of exam urgency levels across the networkand to facilitate a response, if necessary, by the administrator and/orradiologists with respect to prioritizing review of the exams.

As shown in FIG. 3b , the example first screen 300 selectively displaysan examiner scorecard 318. In some examples, the scorecard 320 isdisplayed on a different screen of the user interface 126. The examplescorecard 318 includes an examiner summary viewer 320. As shown in FIG.3b , the examiner summary viewer 320 includes a table containinginformation about one or more radiologists, including, for example,name, specialty, experience level, seniority, and/or total number ofassigned, allocated, and/or accepted exams. A user interacting with thefirst screen 300 can select to view additional information about aradiologist listed in the examiner summary viewer 318, including, forexample, the examiner identifier 314.

An examiner availability indicator 322, which serves as a visualrepresentation of an online status of a radiologist, is also displayedon the example first screen 300. For example, if a radiologist isaccessing the radiology information system 106 of FIG. 1, theradiologist is considered to be “available” for purposes of reviewingthe allocated exam. The examiner availability indicator 322 canrepresent a local presence of the radiologist, a remote presence, anoffline status, and/or another status associated with an availability ofthe radiologist. In some examples, the radiologist selectively sets thestatus of the examiner availability indicator 322 via, for example, theexaminer user interface 204 a of FIG. 2. Selections by the radiologistare dynamically reflected on the screens of the administrator userinterface 202 and the examiner user interfaces 204 a-n.

Any of the exam identifier 302; the exam attribute identifiers 304; theexam status identifiers 306, 308, 310; the examiner identifier 314; thealert 316; the scorecard 318; the examiner summary viewer 320; and/orthe examiner availability indicator 322 can be dynamically updated basedon, for example, implementation of the exam distributor 102 and/or auser's interaction with the user interface 126, including, for example,the administrator user interface 202 or the examiner user interfaces 204a-n. Further, any of the exam or examiner identifiers and/or indicatorscan be represented on the first screen 300, or any other screen of theuser interface 126, using one or more visual representations, including,but not limited to, being flagged/unflagged, highlighted/unhighlighted,displayed/hidden, and/or activated/deactivated. The identifiers andindicators displayed on the example first screen 300 can also beselectively tailored based on, for example, whether the example firstscreen displays information for a radiology department at a hospital oracross a network of healthcare institutions. The order of the display ofthe identifiers and indicators on the example first screen 300 are notlimited to the example illustrations of FIGS. 3 and 3 b. Also, theidentifiers and indicators of the example first screen 300 can beselectively represented by more or fewer icons. For example, instead ofmultiple exam status identifiers 306, 308, 310 to indicate thedistribution status of an exam, a single exam status identifier can beprovided. In some examples, the single exam status identifier can beselectively expanded or collapsed to provide more details about the examdistribution status. In further examples, the exam status identifier(s)and/or the scorecard dynamically update in response to real-time reviewand reporting of exams by radiologists in auto-serve mode to indicate tothe administrator that the exam has been reviewed and to provide acomplete assessment of the exam's workload.

In operation, for example, the example first screen 300 of the userinterface 126 provides a user, such as an administrator of a radiologynetwork, with an overview of one or more exams requiring review and theworkflow distribution status of the exams. For example, the first screen300 allows the administrator to track the allocation, assignment, and/oracceptance of the exams. The first screen 300 also allows theadministrator to track the review status of the exams by displaying, forexample, an alert when an exam is reaching a threshold associated with atime allocated for exam review. Additionally, the first screen 300allows the administrator to selectively view a summary of one or moreradiologists' workloads and/or availability status. In some examples,the first screen 300 provides a snapshot of exam distribution status aswell as the factors, such as radiologist availability, that influenceworkflow distribution of exams by the exam distributor 102. Further, insome examples, the administrator considers the information provided onthe first screen 300 in managing distribution of exams. Thus, theexample first screen 300 serves as a dashboard for an overview of theexam distribution system and a launch pad for further review of workloadallocation.

FIG. 4 illustrates an example second screen 400 of the user interface126 viewable by an administrator (e.g., via the administrator userinterface 202 of FIG. 2). The second screen 400 serves as a radiologistworkflow summary page by listing exams that the radiologist has beenallocated and/or assigned to review by the exam distributor 102. Theadministrator can view the example screen 400 to review a radiologist'sworkload. In some examples, the administrator views the second examplescreen 400 by selecting an examiner identifier 314 associated with aradiologist from the examiner summary viewer 320 of the example firstscreen 300 (FIG. 3). In other examples, the administrator reaches theexample second screen 400 via links provided on one or more otherscreens of the example user interface 126, or directly upon accessingthe user interface 126.

A first portion of the second screen 400 displays identifyinginformation about the radiologist, including, for example, the examineridentifier 314 and/or the examiner availability indicator 322. Thesecond screen 400 also includes a workload availability identifier 402.The workload availability identifier 402 indicates a radiologist'savailability to be allocated and/or assigned exams. For example, basedon one or more load-balancing rules defined by the rules creator 210,the allocation manager 212 and/or the assignment manager 214 (FIG. 2)can refrain from allocating and/or assigning exams to the radiologist ifthe radiologist's workload has surpassed a threshold. Accordingly, theworkload availability indicator 402 can be deactivated to visuallyrepresent that the radiologist is not to be allocated and/or assignedexams. In other examples, the workload availability indicator 402 can beactivated to reflect that the examiner is available to receive examsbased on a current state of the radiologist's workload. In someexamples, the status of the examiner availability indicator 322 isdistinct from the workload availability indicator 402. For example, aradiologist can access and/or log into the radiology information system106 (FIG. 1) and thus, have an online presence, but is unable to beallocated and/or assigned exams because of a workload threshold. Changesto the statuses of the examiner availability indicator 322 and/or theworkload availability indicator 402 are dynamically updated across theadministrator user interface 202 and the examiner user interfaces 204a-n.

A second portion of the example second screen 400 displays anallocated/assigned exam summary 404. The allocated/assigned exam summary404 includes a listing of one or more exams that have been allocated tothe radiologist by the allocation manager 212 (FIG. 2) and/or assignedto the radiologist by the assignment manager 214 (FIG. 2). In someexamples, one or more allocated and/or assigned exams are represented inthe allocated/assigned exam summary 404 by the exam identifier 302. Infurther examples, the allocated/assigned exam summary 404 displays oneor more of the exam status identifiers 306, 308, 310 associated theexam.

A third portion of the example second screen 400 of the user interface126 displays an examiner work queue 406. The examiner work queue 406contains exams that have, for example, been accepted by and/or assignedto the examiner for review. For example, a radiologist can have anoption to accept or reject an exam allocated to the radiologist by theexam distributor 102. Also, as will be discussed below in connectionwith FIG. 5, the administrator can manually assign an exam to theradiologist. The accepted/assigned exams appear in the examiner workqueue 406. An exam can be represented in the examiner work queue 406 by,for example, the exam identifier 302, the exam attribute identifiers304, and/or one or more of the exam status identifiers 306, 308, 310associated with the exam. In some examples, the third exam statusidentifier 310 is flagged to reflect that the exam is in theradiologist's examiner work queue 406.

The second screen 400 also includes a profile selector 408. As describedabove, the profile creator 208 (FIG. 2) optionally provides for aradiologist to create one or more profiles via, for example, theexaminer user interface 204 a-n. The one or more profiles can be basedon, for example, availability and/or specialty practiced during certaintimes or on particular days of the week. A profile can affect thedistribution of exams to the radiologist by the allocation manager 212and/or the assignment manager 214. For example, when a radiologist isassociated with a certain profile, he/she can be allocated and/orassigned no exams, only a certain number of exams, and/or only examshaving certain exam attributes.

The profile selector 408 provides for an administrator to view theradiologist's workload with respect to an available profile created bythe radiologist. By selecting a profile on the example second screen 400(e.g., via a drop down menu), the administrator can view the examsallocated to, assigned to, and/or accepted by the radiologist when theradiologist is associated with the selected profile. Selecting a profiledynamically updates display of, for example, the examiner availabilityidentifier 322 and/or the workload availability identifier 402 based onthe parameters of the selected profile.

In operation, the example second screen 400 of the user interface 126provides for the administrator to view a radiologist-specific workload.For example, the administrator can view exams that have been allocatedto the radiologist by the exam distributor 120. The example secondscreen 400 also enables the administrator to view exams that theradiologist has accepted and, thus, are located in the examiner's workqueue. The information provided on the example second screen 400 can beused by the administrator in evaluating the radiologist's currentworkload in view of, for example, other radiologists. The informationdisplayed via the example second screen 400 can also be used by theadministrator in considering whether to assign additional exams to theradiologist, in some examples overriding the allocation by the examdistributor 102 and/or acceptance/rejection of an exam by theradiologist. Additionally or alternatively, in view of theradiologist-specific information provided on the example second screen400, the administrator considers adjusting one or more of theload-balancing rules associated with the exam distributor 102.

FIG. 5 illustrates an example third screen 500 that can be viewed viathe user interface 126, and in particular, the administrator userinterface 202. In some examples, the example third screen 500 isaccessed by selecting an assignment trigger 502 displayed on the examplefirst screen 300 of FIG. 3. For example, a respective assignment trigger502 is associated with each exam identifier 302 displayed on the examplefirst screen 300. In other examples, the example third screen 500 isaccessed from one or more other screens of the user interface 126.

As described above, the example first screen 300 of FIG. 3 displaysinformation associated with the distribution of exams as well as alertsassociated with time limits for reviewing the exams. Also as describedabove, the example second screen 400 of FIG. 4 displaysradiologist-specific workload information. Based on, for example, theexam distribution and review information displayed via the first screen300 and/or the second screen 400, the administrator can decide tomanually assign an exam to a radiologist. The example third screen 500facilitates such an assignment by serving as an assignment tool.

For example, the administrator can view an exam that has not yet beenallocated and/or assigned to a radiologist via the example first screen300. The administrator can decide to assign the exam to the radiologistbased on, for example, the examiner availability indicator 322associated with a radiologist. To assign the exam, the administrator canselect the assignment trigger 502 associated with the exam via theexample first screen 300. Selection of the assignment trigger 502 cancause the example third screen 500 to display.

In some examples, the example third screen 500 includes a menu 504(e.g., a drop-down menu) of radiologists in the network. The menuincludes the examiner identifier 314 and the associated examineravailability indicator 322. Other information associated with theradiologists can be displayed via the menu 504. Also, in some examples,one or settings can be configured with respect to the menu 504. Forexample, the menu 504 can be configured only to display radiologists whoare available online, as represented by the respective examineravailability indicator 322. In other examples, the administrator canassign an exam to a radiologist who is offline, as represented by theexaminer availability indicator 322.

When the administrator selects to assign an exam to a radiologist viathe menu 504, the exam distributor 102 moves the exam to the selectedradiologist's examiner work queue 406 (FIG. 4). Also, upon assignment,one or more of the exam status identifiers 306, 308, 310 dynamicallyupdates via the administrator user interface 202 and/or the examineruser interfaces 204 a-n to reflect the current status of the exam. Insuch a manner, the example third screen 500 provides for manualassignment of an exam to a radiologist for review.

In operation, the administrator can decide to assign an exam to aradiologist via the example third screen 500 based on one or morefactors associated with the distribution status of exams. For example,activation of the alert 316 indicating that an exam is past due ornearing the expiration time can drive the administrator to manuallyassign the exam to a first radiologist and/or redistribute the exam to asecond radiologist if the exam was previously allocated to the firstradiologist. In some examples, upon review of one or more radiologistworkloads (e.g., via the assignment/allocation summary provided by theexample second screen 400), the administrator decides to redistributethe exams among radiologists. For example, the administrator can assignan exam that was originally allocated by the exam distributor 102 to thefirst radiologist to the second radiologist if, for example, the secondradiologist has a lighter workload than the first radiologist, isavailable to receive work, or requests assignment of the exam. Otherfactors or combination of factors related to exam distribution andreview can contribute to an administrator's decision to utilize theassignment tool features of the third screen 500.

In other examples, the administrator uses the third screen 500 tooverride a radiologist's decision to reject allocation of an exam by theexam distributor 102. As described above, in some examples, aradiologist can selectively accept or reject review of an allocatedexam. If a radiologist rejects an exam, the exam does not appear in theradiologist's work queue 406. If, upon reviewing the radiologist'sworkload and/or history with respect to rejecting allocated exams, theadministrator decides that the radiologist should review the rejectedexam, the administrator can access the example third screen 500 tooverride the radiologist's rejection of the exam and assign the exam tothe radiologist's work queue. In such examples, the radiologist isrequired to review the assigned exam. The administrator can decide tooverride the rejection of the exam if, for example, the radiologist hasa history of rejecting exams having certain attributes, such as examsassociated with a particular body part or modality. The example thirdscreen 500 can be used to prevent such “cherry-picking” of exams byradiologists. Further, the administrator can assign exams toradiologists who are habitually offline to prevent radiologists fromavoiding exam assignments overall.

In some examples, the administrator decides to assign an exam to aradiologist via the example third screen 500 based on one or moremetrics associated with the operation of the exam distributor 102and/or, more generally, the radiology information system 106. Forexample, the administrator is able to view operational statistics and/orperformance metrics associated with the distribution and review of examsvia the administrator user interface 202. Based on metrics related to,for example, exam review efficiency, the administrator can decide toadjust the allocation and/or assignment of exams among radiologists viathe example third screen 500. In other examples, external factorsassociated with the healthcare environment, such as building and/orequipment resources, can drive the administrator's decision to adjustthe exam distribution.

In sum, any combination of the aforementioned factors and/or any otherinternal and/or external factors can influence the administrator toassign an exam to a radiologist via the example third screen 500. Incombination with the example first and second screens 300, 400, theexamples third screen 500 provides for the administrator to influencethe allocation of exams to selected radiologists in response tomonitoring exam and/or radiologist status and in accordance withworkflow goals of the radiology network and/or healthcare institution.

FIG. 6 illustrates an example fourth screen 600 of the example userinterface 126 for interacting with the exam distributor 102 of FIG. 2.In particular, the example fourth screen 600 is viewable by anadministrator via, for example, the administrator user interface 202 ofFIG. 2. As illustrated in FIG. 6, the example fourth screen 600 displaysone or more metrics or statistics associated with the current and/orhistorical operation of the exam distributor 102. The metrics can bepresented in dashboard arrangement and include data displayed ingraphical format, table format, and/or other formats for organizing andpresenting information. In some examples, the metrics displayed on theexample fourth screen 400 are calculated for example, by the calculator218 based on data stored in the database 216 of FIG. 2. In someexamples, the metrics are derived from real-time and/or historical datastored in the database 216 using, for example, data mining techniques.In further examples, the metrics displayed on the example fourth screen400 are dynamically updated during operation of the exam distributor102.

For example, the fourth screen 600 displays historical metricsassociated with distribution and review of exams. As illustrated in FIG.6, the fourth screen 600 displays an exam tracker 602 (e.g., a graph)that characterizes exams over time based on whether or not review of anexam was completed within the allocated SLA time. Such informationallows the administrator to view, for example, exam workloads by month,year, etc. as well as a summary of the performance of the radiologistnetwork in meeting exam review targets over time.

The example fourth screen 600 also displays exam distribution metricsbased on real-time data to reflect the current statuses of andcharacteristics associated with exams requiring review. For example, anexam status summary 604 displays currently pending exams categorized bydistribution status. As illustrated FIG. 6, the exam status summary 604includes a graph visually representing the exams based their status as,for example, allocated, assigned, queued, unassigned, etc. Otherapproaches for organizing data associated with the pending exams canalso be displayed via the example fourth screen 600, including, forexample, pending exams organized by type.

In some examples, the example fourth screen 600 displays metricsassociated with the radiologists reviewing exams distributed by the examdistributor 102 and/or assigned by, for example, the administrator asdescribed above in connection with the assignment tool of FIG. 5. Insome examples, the administrator is interested in viewingexaminer-specific performance metrics including, but not limited to,average turnaround time for reviewing exams, acceptance rate of examsautomatically allocated to the radiologist by the exam distributor 102,examiner efficiency, and/or number of days the examiner wasavailable/unavailable over a period of time. Such radiologist-levelstatistics, displayed via, for example, an examiner performance tracker606 (e.g., a table), can be used by the administrator to evaluate aradiologist's performance over time and/or in view of otherradiologists. Statistics contained in the example examiner performancetracker 606 can also be used by the administrator in assessing theautomatic allocation of exams to radiologists by the exam distributor102. For example, a review of examiner turnaround times as displayed inthe examiner performance tracker 606 can drive the administrator toconsider adjusting one or more of the rules and/or parameters of theexam distributor 102, as will be described below in connection with FIG.7. In other examples, the administrator decides to manually adjust thedistribution of exams based on the examiner performance tracker 606 via,for example, the example third screen 500 of FIG. 5.

In some examples, the example fourth screen 600 further displays metricsassociated with administrative goals, constraints, obligations, and/orother factors that are associated with the distribution and review ofexams at an institutional level. In some examples, as described above, ahealthcare facility has a contractual service level agreement (SLA) witha health insurance provider that associates time allocated for examreview with payment. In some examples, the example fourth screen 600includes an institutional metric reviewer 608 (e.g., a table) containingdata about SLA goals and/or rates over time with associated revenueinformation. In such examples, the fourth screen 600 serves as adashboard for the administrator to view statistics associated with examreview performance that can influence healthcare administration,financial considerations, and/or clinical strategies across the network,healthcare facility, and/or group of healthcare facilitates.

The display of information via the example fourth screen 400 is notlimited to the exam tracker 602, the exam status summary 604, theexaminer performance tracker 606, and/or the institutional metricreviewer 608. Rather, the example fourth screen 400 can display more orless metrics or display the metrics in a different arrangement thanillustrated by FIG. 6. In some examples, the administrator selects oneor more metrics to display on the example fourth screen 600 by adjustingone or more settings via the user interface 126.

The example fourth screen 600 of FIG. 6 serves as dashboard for theadministrator to view one or more operational statistics associated withthe distribution of exams across the radiology network and/or healthcareinstitution. The metrics presented via the fourth screen 600 can bederived using data mining and analytics techniques to facilitate review,and in some examples, action by the administrator with respect to thedistribution of exams. For example, in reviewing a radiologist'sperformance via the examiner performance tracker 606, the administratormay wish to adjust the distribution of exams to the radiologist. In suchexamples, the administrator may prefer to make discrete or one-timeadjustment to the distribution of exams. As described above, the examplefirst and third screens 300, 500 of FIGS. 3 and 5 facilitate a manualadjustment to exam allocation or assignment (e.g., via the assignmenttrigger 502 and the menu 504).

In other examples, monitoring of the historical exam data via the examtracker 602 and/or the institutional metric reviewer 608 can result inthe administrator deciding to adjust the distribution of exams acrossthe radiology network based on patterns, trends, and/or observationsreflected in the data. In some examples, the administrator may wish toimplement or suggest an adjustment to the exam distributor 102 thatinstitutes new exam distribution criteria, prompts a permanent orsemi-permanent change to a distribution parameter, or has other effectsbeyond, for example, a discrete adjustment. To facilitate such anetwork-wide adjustment, the administrator may wish to revise one ormore of the load-balancing rules that drives the allocation of exams.

To implement a rule-based adjustment, the user interface 126 providesfor the administrator to review, and in some examples, edit the rules.FIG. 7 illustrates example fifth screen 700 of the example userinterface 126 for interacting with the exam distributor 102 of FIG. 2.In particular, the example fifth screen 700 is viewable by anadministrator via, for example, the administrator user interface 202 toreview and/or facilitate adjustments to the one or more rules created bythe rules creator 210 of the exam distributor 102 of FIG. 2.

The example fifth screen 700 serves as a rules viewer, in that the fifthscreen 700 provides an overview of the load-balancing rules created bythe rules creator 210. For example, the fifth screen 700 includes anavailable rules summary 702 (e.g., a listing). The available rulessummary 702 displays rules that are available for implementation by theexam distributor 102, but are not currently be used by the examdistributor 102 in allocating exams. The fifth screen 700 also includesan active rules summary 704 (e.g., a listing) that displays rules thatare currently being implemented by the exam distributor 102 in theautomatic allocation and/or assignment of exams to radiologists. In someexamples, factors such as exam characteristics, radiologistcharacteristics, or institutional resources determine whether a rule isavailable or actively being implemented by the exam distributor 102. Insome examples, whether a rule is characterized available or active isdynamically updated based on changes in the aforementioned factorsand/or other internal or external considerations during operation of theexam distributor 102.

The example fifth screen 700 also includes a rule detail summary 706. Byselecting, for example, a rule from the available rules summary 702and/or the active rule summary 704, the rule detail summary 706 displaysdetails about the selected rule, including, but not limited to, criteriasuch as the rule name, a rule description, whether the rule has anyweight in affecting the distribution of exams, and the degree of weightgiven to the rule.

In viewing the available and/or active rules, the administrator may wishto adjust the rules implemented by the exam distributor 102. Using, forexample, a rules controller 708, the administrator can selectivelydesignate that an available rule listed in the available rules summary702 should be actively implemented by moving the selected available ruleto the active rules summary 704. As a result, the exam distributor 102automatically implements the newly designated active rule whendistributing exams. Additionally or alternatively, the administrator canselectively remove an active rule from being implemented by the examdistributor 102 using the rules controller 708. For example, by moving aselected rule from the active rules summary 704 to the available rulessummary 702, the exam distributor 102 no longer implements thedeactivated rule when allocating exams. In such a manner, the rulescontroller 708 provides for the administrator to selectively control theimplementation of rules by the exam distributor 102. For example, basedon one or more metrics viewed via the example fourth screen 600 (FIG.6), the administrator can decide to active or deactivate one or morerules via the example fifth screen 700.

Additionally or alternatively, the example fifth screen 700 provides forediting of one or more of the available rules or the active rules. Asdescribed above, upon selecting a rule from the available or activerules summaries 702, 704, the rules detail summary 706 displays detailsabout the selected rule. Using, for example, a rules editor 710, theadministrator can revise, update, add, delete, or, more generally,change the characteristics associated with the rule. In some examples,the administrator makes changes to, for example, the weight given to therule by the exam distributor 102, based on one or more metrics viewedvia the example fourth screen 600 (FIG. 6). Also, in some examples ofthe fifth screen 700, the administrator has an option to create a newrule and/or delete an existing rule. In response to changes to thedetails associated with the rules via the rules editor 710, the examdistributor 102 automatically implements the rules in accordance withthe adjustments when allocating exams.

In operation, the example fifth screen 700 serves as a rules viewer thatallows the administrator to view the available and active rulesassociated with the distribution of exams by the exam distributor 102.Upon viewing current and/or historical operational metrics associatedwith the distribution and review of exams, the administrator can decideto review the rules via the example fifth screen 700. Further, in someexamples, the administrator may wish to revise one or more of thedetails associated with a rule and/or selectively deactivate or activatea rule from implementation by the exam distributor 102. In adjusting therules via the example screen 700, the administrator can influence theworkflow allocation across the radiology network, as the examdistributor 102 applies the rules in allocating exams for associatedradiologists. Thus, in interacting with the rules viewer of the examplescreen 700, the administrator can selectively influence ruleimplementation and outcomes to facilitate improvements to exam workflowallocation across the network.

In some examples, the user interface 126 enables the administrator toreview and update radiologist attributes that are referenced by the examdistributor 102 in implementing the load-balancing rules. FIG. 8illustrates an example sixth screen 800 of the example user interface126 for interacting with the exam distributor 102 of FIG. 2. Inparticular, the sixth screen 800 is viewable by an administrator via,for example, the administrator user interface 202 to review, and, insome examples, update attributes associated with the radiologists of thenetwork.

As shown in FIG. 8, the example sixth screen 800 displays the examineridentifier 314 and the examiner availability indicator 322. The examplesixth screen 800 can display other radiologist attributes 802,including, but not limited to, specialty, institution, experience level,contact information, etc. In some examples, the administrator updatesone or more of the radiologist attributes 802 via a radiologistattribute editor 804. For example, by selecting the examiner identifier314 associated with a radiologist, the administrator can revise theradiologist's sub-specialty in view of the radiologist's qualificationsvia the radiologist attribute editor 804. Changes to the radiologistattributes via the example sixth screen 800 are dynamically consideredby the exam distributor 102 in automatically allocating exams to theradiologists.

The example sixth screen 800 operates in association with the rulesviewer of the example fifth screen 700 of FIG. 7, and more generally,the examples first through fifth screens of FIGS. 3-7, to provide theadministrator with tools to influence the workflow allocation outcomesby reviewing, editing, updating, adjusting, and/or overriding thedistribution of exams to radiologists. Other screens can additionally oralternatively be provided to the administrator with respect to examdistribution. For example, screens displaying procedural codeinformation, institutional information, and/or calendar views ofradiologist availability profiles can be viewed via the example userinterface 126, and more particularly, the administrator user interface202. In some examples, a user configures the screens and/or theinformation displayed on the screens of the user interface 126.

As described above, the example user interface 126 enables theadministrator to monitor the distribution and review status of examsrequiring review and in some examples, to influence the outcomes of theworkload allocation by instituting radiologist-specific and/ornetwork-level adjustments (e.g., via screens 300-800 of FIGS. 3-8).Whereas in some examples the administrator has an option to makeadjustments based on operational statistics to increase the efficiencyof exam review, the exam distributor 102 also includes an inherentmonitoring and improvement feature to automatically review the examdistribution data, consider user inputs, detect patterns and trendsobservable from the data, and optimizes the parameters of theload-balancing rules that drive the distribution of the exams. In FIG.9, such an automated review is performed by the example optimizer 220 ofthe exam distributor 102 of FIG. 2.

For example, FIG. 9 depicts an example interactive relationship 900between the optimizer 220 of FIG. 2, the screens 300-800 of FIGS. 3-8 ofuser interface 126, and user inputs received via one or moreadministrator and/or examiner workstations 114. For example, theadministrator can access the administrator user interface 202 at therespective workstation 114 and view, for example, the examiner scorecard318, the exam distribution status summary associated with the examplefirst screen 300, the metrics viewer associated with the example fourthscreen 600, and/or the rules viewer associated with the example fifthscreen 700. The administrator can also provide one or more administratoruser inputs 902 via the administrator user interface 202. For example,as described above, the administrator can provide a user input 902 tothe exam assignment tool 502 to direct assignment of an exam to aradiologist.

The administrator can also view the examiner availability indicator 322,the workload availability indicator 402, and/or the examiner work queue406 as part of the administrator's ability to review radiologist andexam workflow characteristics via the administrator user interface 202.Such indicators and identifiers are also viewable by the radiologist viathe examiner user interfaces 204 a-n via the workstations 114. Forexample, a first radiologist can provide an examiner user input 904 viathe examiner user interface 204 to update the examiner availabilityindicator 322 (e.g., to indicate an online or offline presence). Thestatus of the examiner availability indicator 322 is dynamically updatedand viewable to the administrator via the administrator user interface202 as well as to one or more radiologists n via the examiner userinterface 204 n

During allocation of the exams by the exam distributor 102 (e.g., by theallocation and assignment managers 212, 214) and as the administratorand/or the radiologists interact with the user interfaces 202, 204 a-n,the optimizer 220 of the exam distributor 102 continuously monitors theexam distribution, the data generated in connection with the examdistribution, and the user inputs to determine workflow efficiency. Forexample, as exams are allocated to radiologists based on load-balancingrules (e.g., via the allocation manager 212 of FIG. 2), the optimizer220 monitors the examiner work queues 406, changes in examiner and/orworkload availability indicators 322, 402, and the scorecard 318. Theoptimizer also detects user inputs received via the administrator andexaminer user interfaces 202, 204 a-n. For example, the optimizerdetects if an exam was redirected from a first radiologist to a secondradiologist via the exam assignment tool 502. The optimizer also detectsadministrator-initiated changes to the one or more rules via the rulesviewer of the example fifth screen 700.

The optimizer 220 also monitors the statistics and metrics generatedduring the operation of the exam distributor 102. For example, theoptimizer 220 tracks real-time data associated with the distribution ofexams, such as exam review turnaround times, radiologist workloads, andexam type. The optimizer 220 further considers the real-time data inview of historical workflow data previously collected, such asradiologist availability, exam review efficiency, and revenues.Additionally, the optimizer 220 considers inherent attributes orconstraints associated with the distribution of exams, including, butnot limited to, exam difficulty levels, contractual obligations,building resources, and clinical practice standards. The optimizer 220can consider other factors or statistics related to the exams andradiologists. For example, in some instances, the exam distributor 102provides for exams to be auto-served to radiologists for real-timereview of exams, such that the exams are not allocated to theradiologist's work queue, but instead delivered to the radiologist andsubstantially immediately reviewed upon distribution by the radiologistvia the examiner interface 204 a-n. In such examples, the optimizer 220considers the efficiency of the radiologists in reviewing exams thathave been auto-served and the effects of the auto-served exams onradiologist workloads.

In light of the aforementioned metrics and characteristics, theoptimizer 220 detects patterns or trends from the real-time andhistorical data as well as from the user interactions via the userinterfaces 202, 204 a-n. The optimizer 220 measures and analyzes theefficiency of the exam distribution and review process and determinesareas for improvement in the workflow to increase efficiency and/orremove inefficiencies. For example, in view of metrics associated withexam turnaround times, the optimizer 220 can detect an imbalance in examdistribution in light of available resources and radiologists. Theoptimizer considers instances of exam turnaround times that were abovecertain thresholds (e.g., exams reviewed prior to expiration of theallocated time for review) as well as below certain thresholds (e.g.,exams that expired with respect to the allocated review time). Based onan analytic review of the exam distribution process, the optimizer 220develops one or more adjustments to the load-balancing rules directedtoward improving the efficiency of the exam workflow. In some examples,the optimizer 220 analyzes workflow efficiency and develops processimprovements using one or more global optimization models, including,but not limited to Six Sigma, lean optimization, multivariable testing,and/or behavioral approaches.

In some examples, as part of developing a process improvement, theoptimizer 220 considers an impact of the adjustment on the remainder ofworkflow. For example, with respect to a workflow change affectingradiologists associated with a particular specialty, the optimizer 220also considers the impact of the workflows for radiologists notassociated with the particular specialty. In examples where the examdistributor 102 is implemented across one or more institutions, theoptimizer evaluates the impact of the proposed changes across theinstitutions.

In some examples, the optimizer automatically feeds the processimprovement to, for example, the rules creator 210, the allocationmanager 212, the assignment manager 214 (FIG. 2) for implementationduring the operation of the exam distributor 102. In other examples,prior to implementing an adjustment to the load-balancing rules, theoptimizer 220 presents the proposed change to the administrator forapproval via the administrator user interface 202 (e.g., via the rulesviewer of the example fifth screen 700). In such examples, theadministrator can approve or reject the proposed change. Uponimplementation of the optimization or the process improvement, anyresulting changes to the workflow are dynamically reflected throughoutthe exam distributor 102 and the components of the administrator andexaminer user interfaces 202, 204 a-n. Thus, as illustrated in FIG. 9,the optimizer considers data and feedback associated with thedistribution of exams, and also provides for process improvements impactworkflow management.

In some examples, the monitoring and analysis performed by the optimizer220 is continuous during operation of the exam distributor 102. In otherexamples, the optimizer 102 performs data analysis and efficiency reviewas part of a review cycle at specified intervals. Additionally oralternatively, in some examples, the administrator can facilitate theoptimization analysis by the optimizer 220 by directing the examdistributor 102 to perform an analysis in view of metrics generated bythe calculator 218. For example, the metrics viewer of the examplefourth screen 600 and/or the rules viewer of the example fifth screen700 enable the administrator to initiate the optimization process.

In operation, the optimizer 220 operates as part of an interactiverelationship with the components of the exam distributor 102 and theadministrator and examiner user interfaces 202, 204 a-n to optimizeallocation of the exams with the goal of improving workflow efficiency.The optimizer 220 continuously monitors the status of the examdistribution and review and detects patterns with respect to workflowefficiencies and inefficiencies. Based on the monitoring, the optimizer220 develops process improvements directed toward increasing theefficiency of the exam distribution workflow. The optimizer 220complements the review of operational statistics by the administrator inthat the optimizer 220 performs ongoing data analysis to identifyinefficiencies that, in some cases, are not be readily apparent to theadministrator, based on current and historical trends in examdistribution. The optimizer generates process improvements in view ofdetected inefficiencies and in consideration of the impact of theimprovements throughout the exam distribution system. In addition, theoptimizer considers external factors such as hospital legal obligationswhen developing process improvements. The optimizer 220 canautomatically implement improvements to the exam allocation process orcan present the proposed adjustments to the administrator for furtheradministrative review. Thus, the optimizer 220 serves to increase examallocation efficiency.

The optimizer 220 detects patterns with respect to the receipt andreview of exams by radiologists in the network to educate administratorsand radiologists as to opportunities for improvement in workflowmanagement. For example, the exam distributor 102 distributes exams toradiologists, including a first radiologist and a second radiologist,based on availability of the first and second radiologists, expirationof the allocated review time for the exams, and degrees of examdifficulty. In some examples, the first radiologist is available toreview exams in the mornings during the week and the second radiologistis available only two days a week, but for the entire day. The optimizer220 detects patterns in the exam-reviewing behavior of the firstradiologist and the second radiologist during their available times. Forexample, the optimizer 220 references exam turnaround times andefficiency metrics associated with the first radiologist and the secondradiologist (e.g., metrics generated by the calculator 218). In someexamples, the optimizer 220 detects that the first radiologist receivesfewer exams from the allocation manager 212 than the second radiologist,but the first radiologist consistently reviews the allocated examsbefore the expiration of the allocated review time. The optimizer 220also detects that the second radiologist is distributed more exams thanthe first radiologist, receives exams with a higher difficulty level,and has a longer exam turnaround time than the first radiologist.

In response to such examples observations, the optimizer 220 dynamicallyadjusts the load-balancing rules that drive the distribution of exams tothe first radiologist and the second radiologist. In some examples, inview of the shorter exam turnaround time associated with the firstradiologist, the optimizer 220 adjusts the rules so that the firstradiologist receives an increased number of exams associated with lowerdegrees of exam difficulty during his availability periods.Additionally, the optimizer 220 adjusts the rules so that the secondradiologist receives fewer exams on his available days, but the examshave increased difficulty levels. Thus, the optimizer 220 seeks tocapitalize on the first radiologist's efficiency rates by providingfirst radiologist with more exams that can be reviewed within shortperiods of times. The optimizer 220 also directs the exam distributor102 to distribute fewer exams to second radiologist, but which havehigher degrees of difficulty in accordance with the all-day availabilityperiods of the second radiologist. In light of the workflow adjustmentsby the optimizer 220, administrators, as well as the first and secondradiologists can identify opportunities, for example, for the firstradiologist to be regularly referred to for exams requiring minimalreview times or for the second radiologist to develop a practice inreviewing exams associated with certain attributes requiring longerperiods of review.

Flowcharts representative of example machine readable instructions forimplementing the example exam distributor 102 of FIG. 1 are shown inFIGS. 10 and 11. In these examples, the machine readable instructionscomprise a program for execution by a processor such as the processor1212 shown in the example processor platform 1200 discussed below inconnection with FIG. 12. The program can be embodied in software storedon a tangible computer readable storage medium such as a CD-ROM, afloppy disk, a hard drive, a digital versatile disk (DVD), a Blu-raydisk, or a memory associated with the processor 1212, but the entireprogram and/or parts thereof could alternatively be executed by a deviceother than the processor 1212 and/or embodied in firmware or dedicatedhardware. Further, although the example program is described withreference to the flowchart illustrated in FIGS. 10 and 11, many othermethods of implementing the example exam distributor 102 canalternatively be used. For example, the order of execution of the blockscan be changed, and/or some of the blocks described can be changed,eliminated, or combined.

As mentioned above, the example processes of FIGS. 10 and 11 can beimplemented using coded instructions (e.g., computer and/or machinereadable instructions) stored on a tangible computer readable storagemedium such as a hard disk drive, a flash memory, a read-only memory(ROM), a compact disk (CD), a digital versatile disk (DVD), a cache, arandom-access memory (RAM) and/or any other storage device or storagedisk in which information is stored for any duration (e.g., for extendedtime periods, permanently, for brief instances, for temporarilybuffering, and/or for caching of the information). As used herein, theterm tangible computer readable storage medium is expressly defined toinclude any type of computer readable storage device and/or storage diskand to exclude propagating signals and to exclude transmission media. Asused herein, “tangible computer readable storage medium” and “tangiblemachine readable storage medium” are used interchangeably. Additionallyor alternatively, the example processes of FIGS. 10 and 11 can beimplemented using coded instructions (e.g., computer and/or machinereadable instructions) stored on a non-transitory computer and/ormachine readable medium such as a hard disk drive, a flash memory, aread-only memory, a compact disk, a digital versatile disk, a cache, arandom-access memory and/or any other storage device or storage disk inwhich information is stored for any duration (e.g., for extended timeperiods, permanently, for brief instances, for temporarily buffering,and/or for caching of the information). As used herein, the termnon-transitory computer readable medium is expressly defined to includeany type of computer readable storage device and/or storage disk and toexclude propagating signals and to exclude transmission media. As usedherein, when the phrase “at least” is used as the transition term in apreamble of a claim, it is open-ended in the same manner as the term“comprising” is open ended.

FIG. 10 illustrates a flow diagram of an example method 1000 to managemedical exam distribution. The example method 1000 implements the examdistributor 102 of FIG. 2. In particular, the example method 1000includes a method for managing distribution of a medical exam to aradiologist via the administrator user interface 202 of FIG. 2 (e.g.,via the example screens 300-800 of FIGS. 3-8). In some examples, theexample method 1000 can be performed manually by an administrator. Inother examples, the example method 1000 can be implemented via one ormore rules defined by, for example, the administrator via the rulescreator 210 (FIG. 2).

The example method 1000 begins at block 1002 with identifying thecurrent workflow state of the exams requiring review by radiologists. Insome examples, the pending exams are automatically allocated toradiologists by the allocation manager 212 based on one or more rulesdefined by the rules creator 210 of FIG. 2. In some examples, the examsare allocated based on, for example, a radiologist's schedule, a requestby a referring physician to have a specific radiologist review the exam,and/or other user inputs. The allocated exam can be represented on ascreen, such as the exam status summary screen of the example firstscreen 300 of FIG. 3 by an exam identifier 302. The workflow states ofthe exams can be represented on the example first screen 300 by one moreexam status identifiers 306, 308, 310, as being allocated, assigned,queued, etc.

At block 1004, the example method 1000 includes reviewing current and/orhistorical workflow metrics associated with the distribution of exams.For example, the administrator can view one or more metrics associatedwith the exam distribution via the example fourth screen 600, including,but not limited to, exam review efficiency, exams categorized by type,revenues, and examiner availability history. Also, the administrator canview a grouping of examiners by workload and experience via the examinerscorecard 318.

Based on the identification of the current workflow state (block 1002)and the review of the current and/or historical workflow metrics (block1004), the administrator may decide to revise the distribution of one ormore of the currently pending exams. At block 1006, a decision is madewhether to redistribute one or more the exams. If, for example, theadministrator does not wish to revise the exam distribution, the examplemethod 1000 returns to block 1002 for continued monitoring of the examdistribution process by the exam distributor 1002.

If the administrator decides to revise the distribution of exams, theexample method 1000 facilitates adjustments to the allocation and/orassignment of exams to the radiologists. In considering how toredistribute an exam, the administrator can consider various attributesassociated with the exam and the examining radiologists. For example, atblock 1008, the administrator identifies the exam attributes, including,but not limited to, exam modality, body part under review, difficultylevel, and expiration time (e.g., the exam attributes 304, 316 of FIG.3). At block 1010, the administrator identifies attributes associatedwith the radiologists in the network. For example, the administratoridentifies the examiner availability indicator 322 (FIG. 3) and theworkload availability indicator 402 (FIG. 4) of the radiologists toidentify radiologists who are available to receive the exam. Theadministrator can also consider other radiologist attributes, including,for example, radiologist availability profiles, experience level, andspecialty. At block 1012, the administrator reviews the radiologist workqueues (e.g., the work queues 406 of FIG. 4) to identify currentradiologist workloads.

At block 1014, the example method 1000 includes assigning the exam to aradiologist identified based on the review of exam and radiologistattributes conducted at blocks 1008-1010. For example, in view of examspecialty and the amount of allocated time remaining for review of theexam, the administrator can assign the exam to radiologist who iscurrently available, capable of being assigned work, shares thespecialty, and/or has a lighter work queue than the radiologist to whomthe exam was originally assigned. Assignment of the exam at block 1014is facilitated via the exam assignment tool of the example third screen500 (e.g., the assignment trigger 502, the menu 504 of FIG. 5). Uponassignment, the exam appears in the examiner work queue 406 for thenewly selected radiologist. Also, in some examples, the administratorhas reviewed the characteristics associated with the allocated examand/or the first radiologist of blocks 1008-1010, but decides to assignthe exam to the first radiologist in spite of one or more of thecharacteristics. For example, the administrator can assign the exam tothe first radiologist even if the first radiologist is not currentlyavailable (e.g., is offline).

In some examples, the administrator revises distribution of one or moreexams in view of, for example, an isolated or infrequent reason. Forexample, a sudden, but non-permanent change in a radiologist'savailability or a particularly heavy influx of examples that is onlyexpected to be temporary drives the administrator's decision to manuallyreallocate the exam. In other examples, the administrator prefers toimplement the revised exam distribution on a semi-permanent or permanentbasis, on a network-wide level, or as part of a suggested improvement tothe exam distribution process.

At block 1016, a decision is made whether to reconfigure the loadbalancing rules that drive the distribution of the exams. As describedabove, in some examples, the administrator revises the distribution aspart of a discrete event. In such examples, the example method 1000 endsat block 1020, with the administrator continuing to monitor the workflowdistribution.

If a decision is made at block 1016 to reconfigure the rules, theexample method 1000 includes providing feedback to the optimizer of theexam distributor 102 (e.g., the optimizer 202). In some examples of themethod 1000, the administrator provides feedback via the rules viewer ofthe example fifth screen 700 of FIG. 7 by editing one or more theavailable or active rules (e.g., via the rules editor 710). In adjustingthe rules, the example method 1000 provides for the administrator tofacilitate automated suggestions and improvements to the examdistribution process. Such administrator-initiated revisions aredetected by the optimizer 220 in measuring, analyzing, developing, andimplementing efficiency improvements with respect to the one or morerevised rules as well as the workflow process in general. The examplemethod 1000 ends at block 1020 with the administrator continuing tomonitor the workflow distribution in view the revised rules.

In operation, the example method 1000 provides for the administrator toreview the current workflow status of pending exams as well as real-timeand historical operational metrics associated with the workflow. Basedon a review of the exam distribution status and review and patterns andtrends observable from the metrics, the administrator may wish to revisethe automatic allocation of exams by the exam distributor 102. Theexample method 1000 provides for the administrator to re-distributeexams among radiologists as a discrete incident or by adjusting therules used by the exam distributor in automatically allocating exams.Further, the example method 1000 facilitates incorporation of theadministrator's feedback associated with, for example, revisions to theload-balancing rules, into the automated monitoring and optimizationsperformed by the optimizer.

FIG. 11 illustrates a flow diagram of an example method 1100 foroptimizing exam distribution by the exam distributor 102. The examplemethod 1100 can be implemented at least partly by, for example, theoptimizer 220 of the exam distributor 102 (FIGS. 2, 9). The examplemethod 1110 beings at block 1102 with the distributing one or more examsusing the load-balancing rules. For example, the exam distributor 102,including the allocation manager 212, distributes exams using theload-balancing rules defined by the rules creator 210.

At block 1104, the current workflow statuses of the exams requiringreview are tracked by, for example, the optimizer 220. Additionally, atblock 1106, the optimizer 220 retrieves historical data associated withthe allocation and assignment of exams by the exam distributor 102. Thehistorical data can include, for example, numbers of exams distributedper month, revenue generated, examiner availability history, etc. Thehistorical data can be retrieved from the database 216 of FIG. 2.

At block 1108, the calculator 218 of the exam distributor of FIG. 2calculates workflow metrics based on data associated with the currentworkflow statuses (block 1104) and the historical data (block 1106).Such metrics relate to, for example, actual and target exam reviewefficiency rates. Such metrics can also relate to, for example,institutional and/or clinical goals, strategies, and resources.

The example method 1100 includes identifying trends based on theworkflow metrics calculated at block 1106. For example, the optimizer220 employs data mining techniques, statistical analysis, or otheranalytical tools to identify trends inherent in the current andhistorical data associated with the distribution and review of exams.Such trends include, for example, patterns with respect to radiologistsmeeting or not meeting allocated exam review times, frequently receivedtypes of exams, radiologists with the heaviest and lights work queues,patterns in radiologist availability, patterns in radiologist examacceptance histories, etc.

At block 1112, the optimizer 220 evaluates user feedback received viathe user input module 206 of FIG. 2. The user input is received via theuser interface 126 (e.g., the administrator or examiner interfaces 202,204 a-n). For example, via the example assignment tool described inconnection with the example third screen 500 of FIG. 3, theadministrator can enter an input to redistribute the allocation of anexam among radiologists. Also, via the rules viewer of the example fifthscreen 700, the administrator can edit one or more rules used by theexam distributor 102 in distributing exams. In further examples, aradiologist can update the examiner availability indicator 322 (FIG. 3)via the examiner interface 204 a. As part of the example method 1100 foroptimizing exam distribution, the optimizer 220 detects and evaluatesuser feedback with respect to the allocation and assignment of exams.For example, the optimizer 220 can detect repeated re-distribution ofexams associated with certain attributes from a first radiologist to asecond radiologist by the administrator via the exam assignment tool ofFIG. 5. The optimizer also detects repeated rejections of allocatedexams by the radiologist and evaluate whether the administrator hastaken any action to override the rejections.

In reviewing data, identifying trends, and evaluating user feedback asdescribed in connection with blocks 1104-1112, the optimizer 220performs analysis in view of efficiency of the workflow processimplemented by the exam distributor 102. In light of such an analysis,the optimizer 220 detects one or more areas of inefficiencies that couldbe addressed to increase workflow efficiency. At block 1114, a decisionis made by the optimizer 220 regarding whether to update one or more ofthe load-balancing rules defined by the rules creator 210 based onidentified inefficiencies detected from the metrics, trends, andfeedback considered at blocks 1104-1112. The optimizer 220 uses, processimprovement models, including, but not limited to, Six Sigma, leanoptimization, multivariable testing, and/or some combination of globaloptimization models to identify areas for improvements with respect toexam distribution based on the analytical data analysis.

If a decision is made by the optimizer 220 to update one or more of theload-balancing rules, the one or more rules and/or rule parameters areadjusted by the optimizer 220 at block 1116. For example, the optimizeradjusts the weight given to a rule or the frequency in which the rule isimplemented by the exam distributor 102. The optimizer 220 can enactother adjustments to the rule parameters directed toward improving examdistribution efficiency. As described above in connection with FIG. 9,the optimizer 220 considers the impact of the rule adjustments acrossthe exam distribution process associated with radiology network,institution, or group of institutions.

In some examples, the updated rules are automatically implemented by theexam distributor 102. In other examples, the example method 1100optionally includes presenting the proposed updated rule(s) to theadministrator for review, as shown at block 1118. In such examples, theadministrator can approve or reject the updated rule(s), thus, controlwhether the updated rule(s) are implemented. Thus, the example method1100 optionally provides for administrative control of exam distributionoutcomes.

At block 1120, a decision is made whether to distribute additionalexams. If the exam distributor 102 is to distribute additional exams,the distribution is based on the updated rule(s) provided by theoptimizer 220. Thus, the example method 1100 provides for dynamicadjustment of the load-balancing rules during operation of the examdistributor 102 in response to ongoing monitoring of current andhistorical workflow data. As the exam distributor distributes theadditional exams using the updated rule(s), the optimization method ofFIG. 11 repeats to continuously monitor the efficiency of the examdistributor 102. For example, the calculator 218 generates updatedmetrics in view of the impact of the updated rule(s) on the currentworkflow data and the optimizer 220 evaluates the efficiencyimprovements, lack of improvements, and/or negative effects of theupdated rules throughout the workflow process and considers whether tomake further adjustments.

In some examples, if the optimizer 220 determines that a rulesadjustment would not increase the efficiency of the workflow process ormight have a negative effect on one or more aspects of the workflowprocess, the optimizer 220 refrains from adjusting the one or morerules. If, at block 1114, the optimizer 220 determines that, based onthe data analysis, no adjustments to one or more rules should beperformed, the example method 1110 continues to block 1120, where adecision is made to distribute additional exams. If a decision is madeat block 1120 to distribute additional exams, the example method 1100repeats. The optimizer 220 continuously monitors the efficiency of examdistributor 102 and makes real-time decisions with respect to adjustingthe rules during operation of the exam distributor 102. If a decision ismade at block 1120 not to distribute additional exams, the examplemethod 1100 ends at block 1122 with the optimizer 220 continuing tomonitor the status of the workflow process.

In operation, the example method 1100 provides for optimization of theexam distribution process in view of real-time and historical data aswell as user feedback. In performing a data-driven analysis with respectto the efficiency of workflow process, the example method 1100dynamically responds to changes inherently reflected in the collecteddata as well as the influence of user inputs and external variables. Theexample method 1100 can be continuously implemented during operation ofthe exam distributor 102 with a goal of amassing statistics andperformance measures that can be used to further analyze and direct thebehavior of the exam distributor 102. Additionally, the example method1100 can integrate user feedback. Further, the example method 1100 cansupplement and respond to the administrative review described inconnection with the example method 1000 of FIG. 10. In certain examples,the example method 1100 provides for a comprehensive, data-drivenapproach to increasing exam distribution and workflow management.

FIG. 12 is a block diagram of an example processor platform 1200 capableof executing the instructions of FIGS. 10 and 11 to implement the examdistributor 102 of FIG. 1. The processor platform 1200 can be, forexample, a server, a personal computer, a mobile device (e.g., a cellphone, a smart phone, a tablet such as an IPAD™), a personal digitalassistant (PDA), an Internet appliance, or any other type of computingdevice.

The processor platform 1200 of the illustrated example includes aprocessor 1212. The processor 1212 of the illustrated example ishardware. For example, the processor 1212 can be implemented by one ormore integrated circuits, logic circuits, microprocessors or controllersfrom any desired family or manufacturer.

The processor 1212 of the illustrated example includes a local memory1213 (e.g., a cache). The processor 1212 of the illustrated example isin communication with a main memory including a volatile memory 1214 anda non-volatile memory 1216 via a bus 1218. The volatile memory 1214 canbe implemented by Synchronous Dynamic Random Access Memory (SDRAM),Dynamic Random Access Memory (DRAM), RAMBUS Dynamic Random Access Memory(RDRAM) and/or any other type of random access memory device. Thenon-volatile memory 1216 can be implemented by flash memory and/or anyother desired type of memory device. Access to the main memory 1214,1216 is controlled by a memory controller.

The processor platform 1200 of the illustrated example also includes aninterface circuit 1220. The interface circuit 1220 can be implemented byany type of interface standard, such as an Ethernet interface, auniversal serial bus (USB), and/or a PCI express interface.

In the illustrated example, one or more input devices 1222 are connectedto the interface circuit 1220. The input device(s) 1222 permit(s) a userto enter data and commands into the processor 1212. The input device(s)can be implemented by, for example, an audio sensor, a microphone, acamera (still or video), a keyboard, a button, a mouse, a touchscreen, atrack-pad, a trackball, isopoint and/or a voice recognition system.

One or more output devices 1224 are also connected to the interfacecircuit 1220 of the illustrated example. The output devices 1224 can beimplemented, for example, by display devices (e.g., a light emittingdiode (LED), an organic light emitting diode (OLED), a liquid crystaldisplay, a cathode ray tube display (CRT), a touchscreen, a tactileoutput device, a light emitting diode (LED), a printer and/or speakers).The interface circuit 1220 of the illustrated example, thus, typicallyincludes a graphics driver card, a graphics driver chip or a graphicsdriver processor.

The interface circuit 1220 of the illustrated example also includes acommunication device such as a transmitter, a receiver, a transceiver, amodem and/or network interface card to facilitate exchange of data withexternal machines (e.g., computing devices of any kind) via a network1226 (e.g., an Ethernet connection, a digital subscriber line (DSL), atelephone line, coaxial cable, a cellular telephone system, etc.).

The processor platform 1200 of the illustrated example also includes oneor more mass storage devices 1228 for storing software and/or data.Examples of such mass storage devices 1228 include floppy disk drives,hard drive disks, compact disk drives, Blu-ray disk drives, RAIDsystems, and digital versatile disk (DVD) drives.

The coded instructions 1232 of FIGS. 10 and 11 can be stored in the massstorage device 1228, in the volatile memory 1214, in the non-volatilememory 1216, and/or on a removable tangible computer readable storagemedium such as a CD or DVD.

Although certain example methods, apparatus and articles of manufacturehave been disclosed herein, the scope of coverage of this patent is notlimited thereto. On the contrary, this patent covers all methods,apparatus and articles of manufacture fairly falling within the scope ofthe claims of this patent.

What is claimed is:
 1. A system comprising: an exam distributor to automatically distribute a first exam to a first examiner and a second exam to a second examiner based on one or more rules; a first interface, a first user input to be received via the first interface in response to the distribution of the first exam; a second interface, a second user input to be received via the second interface in response to the distribution of the second exam; an analyzer to detect (1) a first trend for the first examiner based on the first user input and at least one metric associated with the distribution of the first exam and (2) a second trend for the second examiner based the second user input and on at least one metric associated with the distribution of the second exam; and a rules viewer to automatically update the one or more rules based on the first trend and the second trend, the exam distributor to automatically distribute a third exam to the first examiner or the second examiner based on the one or more updated rules.
 2. The system of claim 1, wherein the first user input is one of an acceptance of the first exam in an examiner work queue for the first examiner or a rejection of the first exam from the examiner work queue for the first examiner.
 3. The system of claim 1, wherein the second user input is an adjustment to the distribution of the second exam.
 4. The system of claim 1, wherein the analyzer is to perform a comparison of the first trend to the second trend and the rules viewer is to automatically update the one or more rules based on the comparison.
 5. The system of claim 1, wherein the analyzer is to monitor one or more of the distribution of the first exam, the distribution of the second exam, the first input, and the second input, the analyzer to detect the first trend and the second trend based on the monitoring.
 6. The system of claim 1, wherein the analyzer is to update one or more of the first trend or the second trend based on the distribution of the third exam.
 7. The system of claim 1, wherein the at least one metric associated with the distribution first exam includes one or more of a review time of the first exam by the first examiner, an efficiency rate of a review the first exam by the first examiner, and a difficulty level of the first exam.
 8. A method comprising: distributing, by executing an instruction with a processor, a first exam to a first examiner and a second exam to a second examiner based on one or more rules; receiving, via a first interface and by executing an instruction with the processor, a first user input in response to the distribution of the first exam; receiving, via a second interface and by executing an instruction with the processor, a second user input in response to the distribution of the second exam; detecting, by executing an instruction with the processor, (1) a first trend for the first examiner based on the first user input and at least one metric associated with the distribution of the first exam and (2) a second trend for the second examiner based the second user input and on at least one metric associated with the distribution of the second exam; updating, by executing an instruction with the processor, the one or more rules based on the first trend and the second trend; and distributing, by executing an instruction with the processor, a third exam to the first examiner or the second examiner based on the one or more updated rules.
 9. The method of claim 8, wherein the first user input is one of an acceptance of the first exam in an examiner work queue for the first examiner or a rejection of the first exam from the examiner work queue for the first examiner.
 10. The method of claim 8, wherein the second user input is an adjustment to the distribution of the second exam.
 11. The method of claim 8, further including: performing a comparison of the first trend to the second trend; and automatically updating the one or more rules based on the comparison.
 12. The method of claim 8, wherein the detecting of the first trend and the second trend includes monitoring one or more of the distribution of the first exam, the distribution of the second exam, the first input, and the second input.
 13. The method of claim 8, further including updating one or more of the first trend or the second trend based on the distribution of the third exam.
 14. The method of claim 8, wherein the at least one metric associated with the distribution first exam includes one or more of a review time of the first exam by the first examiner, an efficiency rate of a review the first exam by the first examiner, and a difficulty level of the first exam.
 15. A machine readable storage device or storage disk, containing instructions thereon, which when read cause a machine to at least: distribute a first exam to a first examiner and a second exam to a second examiner based on one or more rules; receive, via a first interface, a first user input in response to the distribution of the first exam; receive via a second interface, a second user input in response to the distribution of the second exam; detect (1) a first trend for the first examiner based on the first user input and at least one metric associated with the distribution of the first exam and (2) a second trend for the second examiner based the second user input and on at least one metric associated with the distribution of the second exam; update the one or more rules based on the first trend and the second trend; and distribute a third exam to the first examiner or the second examiner based on the one or more updated rules.
 16. The machine readable storage device or storage disk of claim 15, wherein the first user input is one of an acceptance of the first exam in an examiner work queue for the first examiner or a rejection of the first exam from the examiner work queue for the first examiner.
 17. The machine readable storage device or storage disk of claim 15, wherein the second user input is an adjustment to the distribution of the second exam.
 18. The machine readable storage device or storage disk of claim 15, wherein the instructions, when executed, cause the machine to: perform a comparison of the first trend to the second trend; and automatically update the one or more rules based on the comparison.
 19. The machine readable storage device or storage disk of claim 15, wherein the instructions, when executed, cause the machine to detect of the first trend and the second trend by monitoring one or more of the distribution of the first exam, the distribution of the second exam, the first input, and the second input.
 20. The machine readable storage device or storage disk of claim 15, wherein the instructions, when executed, cause the machine to update one or more of the first trend or the second trend based on the distribution of the third exam. 